Abstract 20: Intraosseous vs. Intravenously Administered Advanced Life Support Drugs in Patients With Out-of-Hospital Cardiac Arrest: Insights From the Resuscitation Outcomes Consortium Continuous Chest Compression Trial

Background: There is an urgent need to identify strategies which improve outcomes for out-of-hospital cardiac arrest (OHCA). Determining the optimal access route to deliver medications during resuscitation from OHCA may be one such strategy. Methods: Using data from the Continuous Chest compression trial between 2011 and 2016, we examined rates of sustained return of spontaneous circulation (ROSC) i.e. ROSC on ER arrival, survival to discharge and survival with favorable neurological function (modified Rankin scale ≤3) among patients with attempted IV and IO access. Results: Among 19,731 patients with available access information, IO or IV access was attempted in 3,068 (15.5%) and 16,663 (84.5%) patients, respectively and was successful in 2,975 (97%) and 15,485 (92%) of these patients. Overall, patients with attempted IO access were younger, more likely female, received less bystander CPR, had lower proportions of shockable and witnessed arrests, marginally faster times to access and to epinephrine administration, and less frequently received therapeutic hypothermia and coronary angiography as compared with patients with IV access ( Table ) . Unadjusted rates of sustained ROSC, discharge survival and survival with favorable neurological function were significantly lower in patients with attempted IO access ( Table) . After adjustment for age, sex, initial rhythm, bystander CPR, public location, witnessed status, EMS response time and trial cluster, attempted IO access was associated with lower sustained ROSC rates (OR 0.79, 95% CI 0.71-0.89, p<0.001) but not with discharge survival (OR 0.88, 95% CI 0.71-1.08, p=0.21) or survival with favorable neurological function (OR 0.86, 95% CI 0.67-1.1, p=0.26). Conclusions: Among patients with OHCA, intraosseous access was attempted in 1 in 7 OHCA patients and associated with worse ROSC rates but no difference in survival. Further studies are necessary to elucidate the optimal access route among OHCA patients.

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Out of hospital cardiac arrest in Western Sydney - an analysis of outcomes and estimation of future eCPR eligibility

10.21203/rs.3.rs-1083706/v1 ◽

2021 ◽

Author(s):

Pramod Chandru ◽

Tatum Priyambada Mitra ◽

Nitesh Dutt Dhanekula ◽

Mark Dennis ◽

Adam Eslick ◽

...

Keyword(s):

Cardiac Arrest ◽

Life Support ◽

Rescue Therapy ◽

A Priori ◽

Advanced Life Support ◽

Spontaneous Circulation ◽

Eligibility Criteria ◽

Extracorporeal Cardiopulmonary Resuscitation ◽

Poor Outcomes ◽

Hospital Cardiac Arrest

Abstract Background Refractory out of hospital cardiac arrest (OHCA) is associated with extremely poor outcomes. However, in selected patients extracorporeal cardiopulmonary resuscitation (eCPR) may be an effective rescue therapy, allowing time treat reversible causes. The primary goal was to estimate the potential future caseload of eCPR at historically 'low-volume' extracorporeal membrane oxygenation (ECMO) centres. Methods A 3-year observational study of OHCA presenting to the Emergency Department (ED of an urban referral centre without historical protocolised use of eCPR. Demographics and standard Utstein outcomes are reported. Further, an a priori analysis of each case for potential eCPR eligibility was conducted. A current eCPR selection criteria (from the 2-CHEER study) was used to determine eligibly. Results In the study window 248 eligible cardiac arrest cases were included in the OHCA registry. 30-day survival was 23.4% (n=58). The mean age of survivors was 55.4 years. 17 (6.8%) cases were deemed true refractory arrests and fulfilled the 2-CHEER eligibility criteria. The majority of these cases presented within “office hours” and no case obtained a return of spontaneous circulation standard advanced life support. Conclusions In this contemporary OHCA registry a significant number of refractory cases were deemed potential eCPR candidates reflecting a need for future interdisciplinary work to support delivery of this therapy.

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Abstract 24: Sex Differences in Outcomes After Out-of-Hospital Cardiac Arrest Patients: Insights From the Resuscitation Outcomes Consortium Continuous Chest Compression Trial

Circulation ◽

10.1161/circ.138.suppl_2.24 ◽

2018 ◽

Vol 138 (Suppl_2) ◽

Author(s):

Purav Mody ◽

Ambarish Pandey ◽

Rohan Khera ◽

Colby Ayers ◽

Mark Link ◽

...

Keyword(s):

Cardiac Arrest ◽

Chest Compression ◽

Regression Models ◽

Neurological Function ◽

Future Studies ◽

Logistic Regression Models ◽

Shockable Rhythm ◽

Bystander Cpr ◽

Sex Disparities ◽

Hospital Cardiac Arrest

Background: Previous studies examining sex-based differences among out-of-hospital cardiac arrest (OHCA) patients have been conflicting. Methods: Patients with OHCA enrolled in the Continuous Chest Compression trial between 2011 and 2016 were included in the present analysis. Hierarchical multivariable logistic regression models were constructed to evaluate the association between sex and sustained ROSC i.e. ROSC on ER arrival, discharge survival and survival with favorable neurological function after adjustment for age, witnessed status, presenting rhythm, public location, bystander CPR, resuscitation duration, and EMS response time. Results: Among 22,540 OHCA patients, 8,099 (35.9%) were women. Women were older (median 71 vs. 67 years), received less bystander CPR (45% vs. 47%), and had a lower proportion of cardiac arrests that were witnessed (39% vs. 45%) or had an initial shockable rhythm (15% vs. 28%, p<= 0.001 for all). There was no difference in sustained ROSC rates (24.7% vs. 24.8%, p=0.7) but discharge survival (6.5% vs. 10.3%, p<0.001) and survival with favorable neurological function (4.9 vs. 8.6%, p<0.001) were significantly lower in women (vs. men). In adjusted analysis, women (vs. men) had significantly higher likelihood of sustained ROSC ( Table ) but no difference in likelihood of discharge survival and survival with favorable neurological function. In the adjusted landmark analysis beginning after achieving ROSC, women had significantly lower likelihood of discharge survival and survival with favorable neurological function ( Table ) . Conclusions: Among resuscitated OHCA patients, women have a higher likelihood of achieving sustained ROSC despite a higher burden of poor prognostic factors. However, after successful ROSC, the likelihood of discharge survival is significantly lower in women (vs. men). Future studies are needed to understand how care provided post-ROSC may modify the sex-disparities in discharge survival outcomes.

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Management of EMS on-scene time during advanced life support in out-of-hospital cardiac arrest: a retrospective observational trial

European Heart Journal Acute Cardiovascular Care ◽

10.1177/2048872620925681 ◽

2020 ◽

Vol 9 (4_suppl) ◽

pp. S82-S89

Author(s):

Michael Poppe ◽

Mario Krammel ◽

Christian Clodi ◽

Christoph Schriefl ◽

Alexandra-Maria Warenits ◽

...

Keyword(s):

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Emergency Medical Services ◽

Life Support ◽

Advanced Life Support ◽

Spontaneous Circulation ◽

Medical Services ◽

Extracorporeal Cardiopulmonary Resuscitation ◽

Emergency Medical ◽

Hospital Cardiac Arrest

Objective Most western emergency medical services provide advanced life support in out-of-hospital cardiac arrest aiming for a return of spontaneous circulation at the scene. Little attention is given to prehospital time management in the case of out-of-hospital cardiac arrest with regard to early coronary angiography or to the start of extracorporeal cardiopulmonary resuscitation treatment within 60 minutes after out-of-hospital cardiac arrest onset. We investigated the emergency medical services on-scene time, defined as emergency medical services arrival at the scene until departure to the hospital, and its association with 30-day survival with favourable neurological outcome after out-of-hospital cardiac arrest. Methods All patients of over 18 years of age with non-traumatic, non-emergency medical services witnessed out-of-hospital cardiac arrest between July 2013 and August 2015 from the Vienna Cardiac Arrest Registry were included in this retrospective observational study. Results Out of 2149 out-of-hospital cardiac arrest patients, a total of 1687 (79%) patients were eligible for analyses. These patients were stratified into groups according to the on-scene time (<35 minutes, 35–45 minutes, 45–60 minutes, >60 minutes). Within short on-scene time groups, out-of-hospital cardiac arrest occurred more often in public and bystander cardiopulmonary resuscitation was more common (both P<0.001). Patients who did not achieve return of spontaneous circulation at the scene showed higher rates of 30-day survival with favourable neurological outcome with an on-scene time of less than 35 minutes (adjusted odds ratio 5.00, 95% confidence interval 1.39–17.96). Conclusion An emergency medical services on-scene time of less than 35 minutes was associated with higher rates of survival and favourable outcomes. It seems to be reasonable to develop time optimised advance life support protocols to minimise the on-scene time in view of further treatments such as early coronary angiography as part of post-resuscitation care or extracorporeal cardiopulmonary resuscitation in refractory out-of-hospital cardiac arrest.

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Factors Influencing Physician Decision Making to Attempt Advanced Resuscitation in Asystolic Out-of-Hospital Cardiac Arrest

10.20944/preprints202107.0447.v1 ◽

2021 ◽

Author(s):

Charles Payot ◽

Christophe A Fehlmann ◽

Laurent Suppan ◽

Marc Niquille ◽

Christelle Lardi ◽

...

Keyword(s):

Cardiac Arrest ◽

Life Support ◽

Advanced Life Support ◽

Multivariable Logistic Regression Model ◽

Physician Decision Making ◽

Factors Influencing ◽

Cardio Pulmonary Resuscitation ◽

Prehospital Emergency ◽

Bystander Cpr ◽

Hospital Cardiac Arrest

The objective of this study was to identify the key elements used by prehospital emergency physicians (EP) to decide whether or not to attempt advanced life support (ALS) in asystolic out-of-hospital cardiac arrest (OHCA). From 01.01.2009 to 01.01.2017, all adult victims of asystolic OHCA in Geneva, Switzerland, were retrospectively included. Patients with signs of "obvious death" or with a Do-Not-Attempt-Resuscitation order were excluded. Patients were categorized as having received ALS if this was mentioned in the medical record, or, failing that, if at least one dose of adrenaline had been administered during cardio-pulmonary resuscitation (CPR). Prognostic factors known at the time of EP's decision were included in a multivariable logistic regression model. 784 patients were included. Factors favourably influencing the decision to provide ALS were witnessed OHCA (OR=2.14, 95%CI1.43–3.20) and bystander CPR (OR=4.10, 95%CI2.28–7.39). Traumatic aetiology (OR=0.04, 95%CI0.02–0.08), age >80 years (OR=0.14, 95%CI0.09–0.24) and a Charlson comorbidity index greater than 5 (OR=0.12, 95%CI0.06–0.27) were the factors most strongly associated with the decision not to attempt ALS. Factors influencing the EP’s decision to attempt ALS in asystolic OHCA are the relatively young age of the patients, few comorbidities, presumed medical aetiology, witnessed OHCA and bystander CPR.

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Sudden cardiac arrest in hypertrophic cardiomyopathy with dynamic cavity obstruction: The case for a decatecholaminisation strategy

Journal of the Intensive Care Society ◽

10.1177/1751143717732729 ◽

2017 ◽

Vol 19 (1) ◽

pp. 69-75 ◽

Cited By ~ 2

Author(s):

Cosmin Balan ◽

Adrian View-Kim Wong

Keyword(s):

Cardiac Arrest ◽

Ventricular Hypertrophy ◽

Life Support ◽

Sudden Cardiac Arrest ◽

Advanced Life Support ◽

Spontaneous Circulation ◽

Left Ventricular ◽

End Diastolic Volume ◽

Death Spiral ◽

Hospital Cardiac Arrest

Catecholamines are entrenched in the management of shock states. A paradigm shift has pervaded the critical care arena in recent years acknowledging their propensity to cause harm and fuel a ‘death-spiral’. We present the case of a 21-year-old male following a witnessed out-of-hospital cardiac arrest who received high-quality cardiopulmonary resuscitation and standard advanced life support for refractory ventricular fibrillation until return of spontaneous circulation after 70 min. Early post-admission echocardiography revealed severe diffuse sub-basal left ventricular hypertrophy with dynamic mid-cavity obstruction and akinetic apical pouching. Within this context, a decatecholaminised strategy comprising a beta-blocker was used to augment the left ventricular end-diastolic volume and attain cardiovascular stability.

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Healthcare professionals’ knowledge on cardiopulmonary resuscitation correlated with return of spontaneous circulation rates after in-hospital cardiac arrests: A multicentric study between university hospitals in 12 European countries

European Journal of Cardiovascular Nursing ◽

10.1177/1474515119900075 ◽

2020 ◽

Vol 19 (5) ◽

pp. 401-410

Author(s):

Christos Kourek ◽

Robert Greif ◽

Georgios Georgiopoulos ◽

Maaret Castrén ◽

Bernd Böttiger ◽

...

Keyword(s):

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Healthcare Professionals ◽

Life Support ◽

Advanced Life Support ◽

Spontaneous Circulation ◽

European Countries ◽

University Hospitals ◽

Return Of Spontaneous Circulation ◽

Hospital Cardiac Arrest

Background: In-hospital cardiac arrest is a major cause of death in European countries, and survival of patients remains low ranging from 20% to 25%. Aims: The purpose of this study was to assess healthcare professionals’ knowledge on cardiopulmonary resuscitation among university hospitals in 12 European countries and correlate it with the return of spontaneous circulation rates of their patients after in-hospital cardiac arrest. Methods and results: A total of 570 healthcare professionals from cardiology, anaesthesiology and intensive care medicine departments of European university hospitals in Italy, Poland, Hungary, Belgium, Spain, Slovakia, Germany, Finland, The Netherlands, Switzerland, France and Greece completed a questionnaire. The questionnaire consisted of 12 questions based on epidemiology data and cardiopulmonary resuscitation training and 26 multiple choice questions on cardiopulmonary resuscitation knowledge. Hospitals in Switzerland scored highest on basic life support ( P=0.005) while Belgium hospitals scored highest on advanced life support ( P<0.001) and total score in cardiopulmonary resuscitation knowledge ( P=0.01). The Swiss hospitals scored highest in cardiopulmonary resuscitation training ( P<0.001). Correlation between cardiopulmonary resuscitation knowledge and return of spontaneous circulation rates of patients with in-hospital cardiac arrest demonstrated that each additional correct answer on the advanced life support score results in a further increase in return of spontaneous circulation rates (odds ratio 3.94; 95% confidence interval 2.78 to 5.57; P<0.001). Conclusion: Differences in knowledge about resuscitation and course attendance were found between university hospitals in 12 European countries. Education in cardiopulmonary resuscitation is considered to be vital for patients’ return of spontaneous circulation rates after in-hospital cardiac arrest. A higher level of knowledge in advanced life support results in higher return of spontaneous circulation rates.

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Assessment of the evolution of end-tidal carbon dioxide within chest compression pauses to detect restoration of spontaneous circulation

PLoS ONE ◽

10.1371/journal.pone.0251511 ◽

2021 ◽

Vol 16 (5) ◽

pp. e0251511

Author(s):

Jose Julio Gutiérrez ◽

Mikel Leturiondo ◽

Sofía Ruiz de Gauna ◽

Jesus María Ruiz ◽

Izaskun Azcarate ◽

...

Keyword(s):

Chest Compression ◽

Life Support ◽

Advanced Life Support ◽

Spontaneous Circulation ◽

Chest Compressions ◽

Average Value ◽

Transthoracic Impedance ◽

Single Feature ◽

End Tidal ◽

Hospital Cardiac Arrest

Background Measurement of end-tidal CO2 (ETCO2) can help to monitor circulation during cardiopulmonary resuscitation (CPR). However, early detection of restoration of spontaneous circulation (ROSC) during CPR using waveform capnography remains a challenge. The aim of the study was to investigate if the assessment of ETCO2 variation during chest compression pauses could allow for ROSC detection. We hypothesized that a decay in ETCO2 during a compression pause indicates no ROSC while a constant or increasing ETCO2 indicates ROSC. Methods We conducted a retrospective analysis of adult out-of-hospital cardiac arrest (OHCA) episodes treated by the advanced life support (ALS). Continuous chest compressions and ventilations were provided manually. Segments of capnography signal during pauses in chest compressions were selected, including at least three ventilations and with durations less than 20 s. Segments were classified as ROSC or non-ROSC according to case chart annotation and examination of the ECG and transthoracic impedance signals. The percentage variation of ETCO2 between consecutive ventilations was computed and its average value, ΔETavg, was used as a single feature to discriminate between ROSC and non-ROSC segments. Results A total of 384 segments (130 ROSC, 254 non-ROSC) from 205 OHCA patients (30.7% female, median age 66) were analyzed. Median (IQR) duration was 16.3 (12.9,18.1) s. ΔETavg was 0.0 (-0.7, 0.9)% for ROSC segments and -11.0 (-14.1, -8.0)% for non-ROSC segments (p < 0.0001). Best performance for ROSC detection yielded a sensitivity of 95.4% (95% CI: 90.1%, 98.1%) and a specificity of 94.9% (91.4%, 97.1%) for all ventilations in the segment. For the first 2 ventilations, duration was 7.7 (6.0, 10.2) s, and sensitivity and specificity were 90.0% (83.5%, 94.2%) and 89.4 (84.9%, 92.6%), respectively. Our method allowed for ROSC detection during the first compression pause in 95.4% of the patients. Conclusion Average percent variation of ETCO2 during pauses in chest compressions allowed for ROSC discrimination. This metric could help confirm ROSC during compression pauses in ALS settings.

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Impacts of Emergency Medical Technician Configurations on Outcomes of Patients with Out-Of-Hospital Cardiac Arrest

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17061930 ◽

2020 ◽

Vol 17 (6) ◽

pp. 1930

Author(s):

Pin-Hui Fang ◽

Yu-Yuan Lin ◽

Chien-Hsin Lu ◽

Ching-Chi Lee ◽

Chih-Hao Lin

Keyword(s):

Cardiac Arrest ◽

Life Support ◽

Advanced Life Support ◽

Spontaneous Circulation ◽

Emergency Medical Technician ◽

Population Database ◽

Emergency Medical ◽

The Impact ◽

Hospital Cardiac Arrest ◽

Medical Technician

Paramedics can provide advanced life support (ALS) for patients with out-of-hospital cardiac arrest (OHCA). However, the impact of emergency medical technician (EMT) configuration on their outcomes remains debated. A three-year cohort study consisted of non-traumatic OHCA adults transported by ALS teams was retrospectively conducted in Tainan City using an Utstein-style population database. The EMT-paramedic (EMT-P) ratio was defined as the EMT-P proportion out of all on-scene EMTs. Among the 1357 eligible cases, the median (interquartile range) number of on-scene EMTs and the EMT-P ratio were 2 (2–2) persons and 50% (50–100%), respectively. The multivariate analysis identified five independent predictors of sustained return of spontaneous circulation (ROSC): younger adults, witnessed cardiac arrest, prehospital ROSC, prehospital defibrillation, and comorbid diabetes mellitus. After adjustment, every 10% increase in the EMT-P ratio was on average associated with an 8% increased chance (adjusted odds ratio [aOR], 1.08; p < 0.01) of sustained ROSC and a 12% increase change (aOR, 1.12; p = 0.048) of favorable neurologic status at discharge. However, increased number of on-scene EMTs was not linked to better outcomes. For nontraumatic OHCA adults, an increase in the on-scene EMT-P ratio resulted in a higher proportion of improved patient outcomes.

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Factors Influencing Physician Decision Making to Attempt Advanced Resuscitation in Asystolic Out-of-Hospital Cardiac Arrest

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18168323 ◽

2021 ◽

Vol 18 (16) ◽

pp. 8323

Author(s):

Charles Payot ◽

Christophe A. Fehlmann ◽

Laurent Suppan ◽

Marc Niquille ◽

Christelle Lardi ◽

...

Keyword(s):

Cardiac Arrest ◽

Life Support ◽

Advanced Life Support ◽

Multivariable Logistic Regression Model ◽

Physician Decision Making ◽

Factors Influencing ◽

Prehospital Emergency ◽

Bystander Cpr ◽

Comorbidity Index ◽

Hospital Cardiac Arrest

The objective of this study was to identify the key elements used by prehospital emergency physicians (EP) to decide whether or not to attempt advanced life support (ALS) in asystolic out-of-hospital cardiac arrest (OHCA). From 1 January 2009 to 1 January 2017, all adult victims of asystolic OHCA in Geneva, Switzerland, were retrospectively included. Patients with signs of “obvious death” or with a Do-Not-Attempt-Resuscitation order were excluded. Patients were categorized as having received ALS if this was mentioned in the medical record, or, failing that, if at least one dose of adrenaline had been administered during cardiopulmonary resuscitation (CPR). Prognostic factors known at the time of EP’s decision were included in a multivariable logistic regression model. Included were 784 patients. Factors favourably influencing the decision to provide ALS were witnessed OHCA (OR = 2.14, 95% CI: 1.43–3.20) and bystander CPR (OR = 4.10, 95% CI: 2.28–7.39). Traumatic aetiology (OR = 0.04, 95% CI: 0.02–0.08), age > 80 years (OR = 0.14, 95% CI: 0.09–0.24) and a Charlson comorbidity index greater than 5 (OR = 0.12, 95% CI: 0.06–0.27) were the factors most strongly associated with the decision not to attempt ALS. Factors influencing the EP’s decision to attempt ALS in asystolic OHCA are the relatively young age of the patients, few comorbidities, presumed medical aetiology, witnessed OHCA and bystander CPR.

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Abstract 13106: Improved Outcomes of Extracorporeal Cardiopulmonary Resuscitation for Out-of-hospital Cardiac Arrest - A Community-wide Evaluation

Circulation ◽

10.1161/circ.132.suppl_3.13106 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Wei-Shu Lin ◽

Matthew Huei-Ming Ma ◽

Nai-Kuan Chou ◽

Mei-Fen Yang ◽

Yu-Wen Chen ◽

...

Keyword(s):

Neurological Outcome ◽

Life Support ◽

Cerebral Performance Category ◽

Advanced Life Support ◽

Spontaneous Circulation ◽

Extracorporeal Cardiopulmonary Resuscitation ◽

Improved Outcomes ◽

Advanced Airway ◽

Bystander Cpr ◽

Hospital Cardiac Arrest

Introduction: The patient outcome after OHCA is poor. Return to spontaneous circulation (ROSC) dramatically decreases with the duration of CPR. It has been proposed to implement extracorporeal membrane oxygenation in order to assist CPR (ECPR) in OHCA. Objective: To investigate the effects of ECPR in emergency (ED) for OHCA. Methods: A prospective 4-year observational database collected from a community-wide OHCA registry in an urban EMS was studied. The EMS ambulance staffs were capable with advanced airway, intravenous (iv) fluid skills, basic and advanced life support and AED techniques. Outcomes included 2-hour and 24-hour sustained ROSC, survival (SD) and cerebral performance category scale (CPC) at discharge. OHCA receiving ECPR were included and their pre-hospital (pre-H) and hospital (H) characteristics and outcomes were evaluated by regression analysis. Results: In the 4 years among a total of 7,220 OHCA resuscitated in ED, ECPR was used 88 times (90% male, median age 54 [IQR 44-63]), 90% non-traumatic, 58.6% arrest witnessed, 50.6% with bystander CPR, up to 72.6% initial AED rhythm showing shockable, 54% with LMA (laryngeal mask airway), 5.7% with endotracheal intubation, 18.2% with pre-H iv epinephrine, and 12.5% of them received therapeutic hypothermia. Pre-H time intervals (min:sec, median [IQR]) were 04:38 [03:30-06:08] for response, 13:00 [10:05-16:00] for scene, and 03:08 [02:09-05:00] for transport. Only 10.2% of cases presented pre-H ROSC and 9.1% got ROSC upon H arrival. Outcomes were 88.6% for 2-hr ROSC, 69.3% for 24-hr ROSC, 39.1% for SD, and 21% for good CPC 1or2 respectively. Patients with CPC 1or2 tended to be younger (median age 46.8 vs. 55.9, p=0.04) and less with LMA (29.4 vs. 61.9%, p=0.02). Conclusions: ECPR can lead to survival and good neurological outcome in selected OHCA regardless of positive ROSC at pre-H or upon H arrival after EMS resuscitation. Elder age and pre-H LMA may be adverse to neurological outcome for OHCA with ECPR.

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